COVID: longterm symptoms

it is pretty clear that many people have residual symptoms after Covid-19 that can last for at least 1+ months (sometimes much longer), and in my limited anecdotal experience, the most common one is fatigue (though anosmia/dysgeusia can also last a long time). there are some ongoing studies to look at these longer term symptoms (eg CORAL: see https://www.nhlbi.nih.gov/news/2020/looking-forward-understanding-long-term-effects-covid-19 or https://www.omf.ngo/2020/04/26/tracking-covid-19-patients/ ). 

A recent article in The Atlantic focused on 9 people considered "long-termers" or "long-haulers": see https://www.theatlantic.com/health/archive/2020/06/covid-19-coronavirus-longterm-symptoms-months/612679/, brought to my attention by Hannah Webb and Emily Lowenberg.  These nine people were relatively young and had what was considered mild Covid-19 infections. but, so far, they have had months of subsequent prolonged disabling symptoms, that may wax and wane, or be brought on by exertion, and profoundly affect their lives. Many of these symptoms are neurologic, some GI, some prolonged fever, some a recurrence of their early symptoms, some body aches. And, the medical establishment, as well as friends/relatives, are often dismissing these symptoms as stress, overreacting, being wimpy, or some variant of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome or complex regional pain syndrome.

one of the interviewed people in The Atlantic article is Paul Garner, a professor of tropical medicine at the Liverpool School of Tropical Medicine, who writes about his own 7-week "roller coaster of ill health, extreme emotions and utter exhaustion" in an article in BMJ Opinion from 5 May 2020 (see https://blogs.bmj.com/bmj/2020/05/05/paul-garner-people-who-have-a-more-protracted-illness-need-help-to-understand-and-cope-with-the-constantly-shifting-bizarre-symptoms/ )

so, lots more to study and understand about SARS-CoV-2 and Covid-19.  why do some people have no or a few days of mild symptoms, yet others get really sick? may well be related to the level of the inflammatory/immune response. but it is interesting from the anecdotal descriptions in this article that these prolonged symptoms seemed to happen in somewhat younger people with not-so-severe symptoms (and, presumably less severe inflammatory/immune responses).  but, with the huge numbers of Covid-19 cases, we are likely to see huge numbers of people with prolonged symptoms. so, understanding what is going on, why some people get it, and what we can do is extremely important, both to potentially decrease its occurrence of long-term symptoms (would early anti-inflammatory meds help??) or later on to treat it effectively.

as a related issue: Lancet Psychiatry had a recent article on 153 patients in the UK with neuropsych issues associated with Covid-19, compiled over a 2-3 week period (see covid neurolopsych symptoms lancetneuro2020 in dropbox, or doi.org/10.1016/S2215-0366(20)30287-X). Many had strokes (more ischemic than hemorrhagic), smaller numbers with encephalitis, change in mental status (half younger than 60yo), new onset psychoses, neurocognitive (dementia-like) syndrome, and affective disorders.  

--They do include chronic fatigue syndrome as part of their clinical case definitions, though by definition this involves symptoms present for at least 6 months (which predates the significant outbreak in the UK)

--and, there is no other mention of fatigue in the article, though it seems that prolonged fatigue is one of the more common neuropsych symptoms (and was certainly highlighted in The Atlantic article above)

geoff

 

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